exam 2 Flashcards
(95 cards)
1
Q
koebner phenomenon
A
- trauma to an area on skin -> psoriatic patch
2
Q
auspitz sign
A
- if you peel of silvery scaling in psoriasis it will bleed
3
Q
nikolsky sign
A
- press edge of bullae/ vesicle and top epidermal layer separates
4
Q
treatment for drug eruptions
A
- d/c offeding agent
- antihistamines around the clock
- topical steroids BID for pruritis
- PO prednisone if bad
5
Q
SJS and TEN
A
- TEN covers 30% or more of total body surface area
- skin comes off in sheets
- mucosal loss
- admit to burn unit/ ICU
6
Q
common causes of SJS or TEN
A
- phenytoin
- carbamazepine
- piroxicom
- allopurinol
- vaccines
7
Q
class I steroids
A
- very potent
- severe non-facial and non- intertriginous areas
- scalp, palms, soles, on thick plaques
- use for < 4 weeks
- i.e. clobestasol
8
Q
class II steroid
A
- high potency
- used on non-facial and non-intertriginous areas
- i.e. mometasone, fluocinonide
9
Q
class III-V steroids
A
- medium potency
- non-facial and non-intertrignous areas
- ok on flexor surfaces for short periods
- can use for < 6-8 weeks
- i.e. mometasone, triamcinolone
10
Q
class VI-VII
A
- least potent
- used for larger areas, thinner skin
- face, eyelids, genitals
- limit to 1-2 weeks on face and eyelids to avoid atrophy
- i.e. desonide, hydrocortisone
11
Q
steroid absorption
A
- better absorbed in areas of inflammation and desquamation
- ointments have higher absorption and potency
- avoid occlusive dressings d/t atrophy and hypopigmentation
12
Q
how do you dose steroids
A
- based on rule of 9s
- size of palm = 1% BSA
- dose 0.5 grams for 2% of BSA
- one finger tip= 0.5 grams
- one 30 gram tube will cover an entire adult body
13
Q
how should you treat hair and nail fungal infections
A
- systemic anti-fungals
- dont respond well to topicals
14
Q
what is the best treatment for candida
A
- nystatin
- not absorbed well in GIT
- candida= yeast normally found on mucous membranes, GIT and skin
15
Q
what is the best treatment for dermatophytes
A
- allylamines
- naftifine
- terbinafine
- butenafine
16
Q
stage I HTN
A
- 130-139/ 80-89
17
Q
stage II HTN
A
- > 140/90
18
Q
lifestyle modifications to treat HTN
A
- Na restriction to < 1500 mg/day
- weight loss
- exercise- 90-150 min a week
- mod alcohol intake
- eating K-rich foods
19
Q
how much impact do lifestyle modifications have on BP?
A
- each likely to reduce SBP by 3-8 mmHg, DBP by 1-4 mmHg
20
Q
what meds should pts with HTN avoid
A
- NSAIDs
- decongestants
- amphetamines
21
Q
thiazide diuretics
A
- net loss of Na and water in urine
- after 4-6 weeks of tx Na balance and CO regained but BP remains low
- decreases TPR because Na causes vascular stiffness
- average fall in BP on low dose is 10 mmHg
22
Q
how long does HCTZ work
A
- 24 hours
23
Q
were do thiazide diuretics work
A
- distal convoluted tubules
24
Q
ADRs of thiazide diuretics
A
- hypokalemia -> possible torsades and sudden death
- hyperglycemia
- hyperlipidema (stroke risk)
- hyperuricemia
25
at what doses are metabolic effects seen for thiazides
- high doses- 50-100 mg/ day
| - dont see them at low doses of 12.5-25 mg
26
name the thiazide diuretics
- HCTZ
- chlorthalidone
- metolazone
- indapamide
- chlorothiazide
27
name the loop diuretics
- furosemide/lasix
- torsemide
- bumetanide
- ethacrynic acid
28
where do loop diuretics work
- loop of henle/ thick ascending limb
29
what are the classes of k sparing diuretics
- aldosterone antagonists
| - Na channel blockers
30
list the aldosterone antagonists
- spironoloactone
| - eplerenone
31
list the Na channel blockers
- amiloride
| - triamterene
32
where do k sparing diuretics work
- collecting ducts
33
when is renin secreted and from where?
- secreted from kidneys
- decreased arterial BP
- decreased Na
- increased sympathetic activity
34
what does renin act on?
- angitensinogen to convert it to angiotensin I
35
how do you get angiotensin II?
- angtiotensin I converted to angiotensin II via ACE
36
main role of angiotensin II
- powerful vasoconstrictor
- causes aldosterone release -> Na retention
- mainly concerned about the ATI receptor
37
other effects of angiotensin II
- vasoconstriction of renal arterioles -> glomerular damage
- decreased NO release
- decreased fibrinolysis in blood
- increased thirst
- mitogenic effect- cell proliferation
38
overall "bad" effect of angiotensin II
- volume overload and increased TPR
- cardiac hypertrophy/ remodeling
HTN
- myocardial infarction
- renal damage
- CV morbidity and mortality
39
benefits of ACEI
- reverse cardiac and vascular hypertrophy
- no postural hypotension or electrolyte abnormalities
- safe in asthmatics and diabetics
- reverse ventricular hypertrophy
- increase lumen size
- no rebound HTN
- no hyperuricemia, lipid impact
- renal perfusion maintained
- prevent secondary hyperaldosteronism and K loss
40
indications for ACEI
- HTN
- CHF
- MI
- prophylaxis of high CV risk pts
- diabetic nephropathy
- scleroderma crisis
41
side effects of ACEI
- cough d/t bradykinin inhibition
- angioedema
- hyperkalemia- in renal failure, k sparing diuretics, NSAIDs
- AKI
42
contraindications for ACEI
- pregnancy
- bilat renal artery stenosis
- hypersensitivity
- hyperkalemia
43
ARBs
- specific to AT1 receptors
- less incidence of cough
- get vasodilation
44
CCB
- cause SMC relaxation and vasodilation
- non-DHPs good for rate control
- no metabolic effects
- no sedation
- can be given in asthma, angina, and PVD
- no renal or male sexual dysfunction
45
contraindications for CCB
- unstable angina
- HF
- hypotension
- post infarct
- severe aortic stenosis
46
list some nonselective BB
- propranolol
- nadolol
- timolol
- pindolol
- labetolol
47
list some selective BB
- metoprolol
- atenolol
- esmolol
- betaxolol
48
effect of BB
- both classes have similar anti-HTN effect
- reduce CO and BP slowly
- reduce Na release
- central sympathetic outflow reduction
- nonselective BB reduce GFR
49
advantages of BB
- no postural hypotension
- no Na and water retention
- low incidence ADRs
- low cost, dosed once a day
- pref in young non-obese pts
- prevent sudden cardiac death in post MI pts and progressive CHF*
50
patients you should consider cardio-selective BB in
- young non-obese HTN
- angina pectoris and post angina pts
- post MI pts
- carvedilol in elderly- vasodilatory effect
51
ADRs of BB
- fatigue, lethargy, decreased work capacity
- loss of libido/ impotence
- forgetfulness
- bradycardia
- bronchospasm
- c/i in insulin dependent diabetics
- increased TG, decreased HDL
52
what drugs should not be combined with BB
- CCB
| - NSAIDs blunt BB effect
53
alpha adrenergic blockers
- not used in chronic essential HTN
- may be used for pheochromocytoma
- really only used for BPH
- can be adjunct when pts failing diuretics or BB
54
ADRs of alpha adrenergics
- postural hypotension
- fluid retention when used as monotx- avoid in CHF
- HA
- dry mouth
- weakness
- blurred vision
- rash
- drowsiness
- failure to ejaculate
55
hydralazine MOA
- direct acting vasodilator
| - liberates NO and decreases TPR
56
hydralazine indications
- NOT as monotx
| - only in severe or refractory HTN
57
ADRs of hydralazine
- rebound tachycardia
- hypotension
- fluid retention
- lupus like syndrome
58
mechanism sodium nitroprusside
- RBCs convert nitroprusside to NO
- direct acting vasodilator
- rapid acting
- reduces TPR and CO
59
nitroprusside indications
- HTN emergency
| - improves ventricular fn in HF by reducing preload
60
ADRs of nitroprusside
- palpitations
- abdominal pain
- disorentation
- psychosis
- weakness
- lactic acidosis
- d/t release of cyanides
61
methyldopa
- centrally acting
- prodrug
- used for HTN in pregnancy
62
ADRs of methyldopa
- cognitive impairment
- postural hypotension
- pos coombs test
63
HTN and CKD
- ACEI and ARB preferred
| - CKD- abnormal kidney structure and fn present for > 3 mo, usually classified based on albuminuria > 30
64
HTN and elderly
- favorable data for low dose thiazides
- some data for DHP, CCB, ACEI
- consider fall risk and hypoperfusion
- tight BP regulation -> decreased blood to brain -> syncope
65
HTN and blacks
- thiazides and CCB preferred for monotx
- have low plasma renin activity
- increased Na/fluid loading
- very responsive to thaizides
66
diabetes and HTN
- no role in deciding initial tx
- ACE/ARB should be part of regimen, esp first line if albuminuria
- prefered to reduce/ prevent nephropathy
67
resistant HTN
- BP above goal despite use of 3+ meds
- usually diuretic + ACEI/ARB + CCB
- must r/o secondary causes before you dx someone with resistant HTN
68
risk factors for resistant HTN
- age, female
- high BP at baseline
- obesity
- salt intake
- CKD
- DM
- LVH
- AA
69
secondary causes for HTN
- obstructive sleep apnea
- primary aldosteronism
- advanced CKD or renal artery stenosis
- volume overload
- excessive alcohol intake
- obesity
- meds
70
meds to check if pt is using before dx of resistant HTN
- NSAIDs, COX2
- vasoconstrictors
- stimulants, cocaine, illicit drugs
- decongestants
- diet pills
- OCP
- steroids, cyclosporine, tacrolimus
- erythrpoietin
71
meds to treat resistant HTN
- k sparing diuretics- spironolactone best
- BB- can consider if HR > 80 bpm, usually carvedilol or labetolol
- alpha 1 blockers if low HR and/or BPH
72
PO drugs that cover MRSA
- bactrim
- clindamycin
- tetracyclines
- linezolid
73
IV drugs that cover MRSA
- vanco
- daptomycin
- linezolid
- tigecycline
- telavancin
- ceftaroline
74
drugs that cover pseudomonas
- zosyn
- cetazidime
- cefepime
- fluoroquinolines (only PO option from list)
- aztreonam
75
treatment for MSSA infections
- dicloxacillin PO
- nafcillin or oxacillin IV
- cefazolin, cephalexin, cefadroxil
- bactrim
76
treatment for otitis media
- amoxicillin first line
- augmentin ES if recurrent or severe
- ofloxacin drops- tubes or perf
- bactrim, axithromycin or clinda if PCN allergy
- IM ceftriaxone one dose of pt is throwing up
77
risk factors for otitis media
- parents who smoke
- not breast fed
- sleeping with bottle
- not vaccinated
78
treatment for lyme disease
- doxycycline first line- 100 mg BID X 21 days
| - amoxicillin or cefuroxime as alt for pregnancy or kids
79
abx to avoid in pregnancy
- bactrim
- fluoroquinolones
- tetracyclines
80
abx to avoid in kids
- tetracyclines
- fluoroquinolones
- consider child if med is administered to breast feeding mother
81
fluoroquinolone ADRs
- BBW tendinopathies
- hypo/hyperglycemia
- delirium in elderly
- QTc prolongation
- decreased seizure threshold
- c/i in kids and pregnancy
82
which drugs have seizure risk
- all beta lactams if not dosed based on renal function
- highst- cefepime, carbapenems
- fluoroquinolones
83
treatment for throat infections
- PCN
| - macrolide of PCN allergy
84
most common cause of throat infections
- strep pyogenes
85
most common cause of otitis media
- s pneumoniae
- f flu
- m catarrhalis
86
when do you use MRI for ortho
- soft tissue eval
- occult fx eval
- need xray first
87
when do you use CT for ortho
- obvious fx seen on xray -> surgical planning
| - assess articular surface
88
when do you use US for ortho
- injection guidance
| - superficial tissue eval
89
treatment for stable fx
- splint
- crutches/ sling
- RICE
- pain meds
- refer to ortho
90
treatment for unstable fx
- splint
- pain meds
- consult ortho
- further imaging?
- surgery?
91
treatment for sprain
- splint/ boot
- sling/ crutches
- RICE
- NSAIDs/ tylenol
92
treatment for tendinosis/ tendinopathy
- splint/ sling
- RICE
- NSAIDs/ tylenol
- PT
- refer to ortho
93
treatment for dislocation
- get xrays
- pain meds
- reduce joint
- crutches/ sling
- RICE
- refer to ortho
94
treatment for disc herniation +/- radiculopathy
- steroid taper
- pain meds?
- MRI?
- refer to ortho
95
treatment for metastatic lesions
- further imaging like MRI or bone scan?
- consult ortho
- ORIF/ IM rodding/ hemiarthroplasty?
- pain meds?
